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AP headline about prostate treatment .... $93,000 cancer drug

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Posted 9/27/2010 2:40 AM (GMT 0)
 

http://www.google.com/hostednews/ap/article/ALeqM5gX4eP9olr-BpEqV7WSPw3NtSM-oQD9IFMQN00

I know that this is an older discussion here, but when AP throws a headline out like this, the public will ask... why?

I do too, It just points again that we need to continue to attack the pharma giants and pass new healthcare legislation.

Posted 9/27/2010 4:05 AM (GMT 0)
When drugs were developed to treat the aids epidemic, the costs were staggering and few could afford treatment..As this disease swept across Africa and Asia, these people went virtually untreated because no one could afford the drugs..

Before long, third-world drug manufacturers discovered they could make the required "cocktail" of pills for a tiny fraction of the prices charged by U.S. pharmaceutical companies who held the patents..Some sort of agreement was reached, victims in third world countries soon had access to low-cost treatment while patients in the U.S. continued to pay much more...

Many people on this board use off-shore pharmacies to supply them with ED and cholesterol drugs that command outrageous prices in the U.S....

A big step forward would be for the pharmaceutical companies to reveal the actual cost to manufacture these "life saving" drugs..

Things can really get twisted when the Government and NPO's pay or at least contribute to the development of these drugs, then the Government is the primary buyer of the drugs but pays prices set by a private company who was granted an exclusive use patent and never reveals what it actually costs to produce the drug..They scream "No Socialism" but they don't complain when Medicare agrees to pay $93,000 for a Provenge treatment...That's buttering your bread on both sides...

Our Nation can not absorb these exploding medical treatment costs..How many times have you heard "I don't care, my insurance paid for it all"...Well insurance companies can not afford to absorb these costs forever either and they will certainly pass them on or stop writing medical insurance....Then we will all have to answer the question: Is the treatment cost worth the result?? Who decides?? JMHO...
Posted 9/27/2010 3:17 PM (GMT 0)
I view this debate differently. I want the big pharma and small start ups feeding them to be interested in investing tons of money in R&D. To do this, they have to see profit from the risky investments they make. I am looking at profitability of the pharma companies and I don't see it being out of line with other companies like Apple, Ford, IBM, etc.
Posted 9/27/2010 4:10 PM (GMT 0)
Big Pharma spends more money on marketing than they do R&D....Pharmacists, the pill counters at the prescription drug counter, ALL make over 100K a year unless they choose to work part-time..

There is NOTHING in place in the United States to check health-care costs...It's like our system was designed to maximize health-care costs..
Posted 9/27/2010 4:51 PM (GMT 0)
There's only one reason heads of states of other countries come to the US when the chips are down on their health, (recent examples being prime ministers of Canada and Italy). US pharma's have been given a business environment that provides them the incentive to become a business and to invest heavily in research. And businesses have one primary obligation; to stay in business by being profitable, which in the long run requires a good product too. Take away profitability and you take away it's reason for existence. Take away their ability to recover heavy investments and you take away profitability. If you only allow mediocre profits, you get mediocre products.

Keep government out of pharma industry or we'll get medical deliveries on a par with our mail deliveries.
Posted 9/27/2010 5:47 PM (GMT 0)
I suppose I read the point of the article a little differently. As I saw it the point was is this cost excessive for the meager benefit one gains? And secondly would one pay this if not insured? Also not addressed is the QOL of the receiver of the drug. Is this just three more months of misery in the final stages? I once read that the last six months of a persons life was where the majority of the medical expense occurs in a lifetime. I believe this is true. In my own case I have a living will specifying no "heroic measures". Hospitals hate that because they cannot justify draining your bank account and cheating your heirs.

On another subject somewhat off topic but still applicable is another article I read about drug development. I forget the numbers but the majority of drugs approved by the FDA in the last ten years did not have a curative intent nor benefit. (This is all drugs not just cancer) Most were aimed at relieving a symptom.

Don

Posted 9/27/2010 6:42 PM (GMT 0)

Two points...

First, keep in mind that this was a major breakthough, but not the endpoint.  This is the first so-called cancer vaccine, and the progress which has been made will be further developed & refined.  The next breakthrough will extend life, perhaps, from a couple months to a couple years...but the researchers had to walk before they ran.  Don't think of Provenge as the endpoint.

Second, the cost of Provenge is not so much wrapped-up in the drug as it is the treatment.  Provenge treatments seek to "re-train" the immune system to fight prostate tumors.  From the article, "Part of why it costs so much is that it's not a pill cranked out in a lab, but a treatment that is individually prepared, using each patient's cells and a protein found on most prostate cancer cells. It is expensive and time-consuming to make."

Major step forward in the prostate cancer fight.

Posted 9/27/2010 6:58 PM (GMT 0)
Insurance companies pay for NOTHING!! They spread the cost of medical treatment over all the people in the "group" that's insured and they earn a nice profit by providing this service. When the COST of providing this treatment skyrockets, the premiums they charge must also skyrocket...

Today, very few un-insured people can afford to pay for cancer treatment out-of pocket. Uninsured families are quickly bankrupted..It won't be long before insurance premiums will have the same effect, their cost beyond the reach of most private employers or self-employed people..

What good is a cancer cure if it costs so much nobody can afford it other than the top 5% of our citizens?
Posted 9/27/2010 7:50 PM (GMT 0)
Earlier today I posted two points to consider in this thread; I'll add a third point here:

Third, keep in mind that the Provenge phase-3 trial showed a median improvement of 4.5 months survival.  As you probably know, the way these drugs work is that they do work for some people, and others they simply don't work for.  So, some men had far greater survival than the 4.5 month median value.  The trial is required to report 3-year results, where 34% of the patients on Provenge were still alive, versus 11% for the placebo.  In other words, the odds of being alive 3-years later were 3-times higher for those who took Provenge.

 

To my point earlier that Provenge is not the "endpoint", keep your eyes out for Zibotentan, which may be the next advancement beyond Provenge.  The phase-2 median survival benefit was 7 months, and the daily pill format is cheaper and more convenient to administer to patients.

 

 

edit:  typo

Post Edited (Casey59) : 9/27/2010 2:16:34 PM (GMT-6)

Posted 9/27/2010 10:34 PM (GMT 0)
There was an essay in yesterday's Democrat and Chronicle: Economics of Prostate Cancer discussing the cost issue for any treatment:
Watchful waiting
Surgery $20K
Targeted Radiation like IMRT 450k
Proton beam $100k.

The essay was written by Drs Valvo and NMadeb.
They didn't offer up a solution. Does anyone have one?
How about:
The 2 million max lifetime limit? The 10% self pay? The pay to play?
Or upon death all assets go to pay back reimbursed health care costs?

This situation will only get worse as technology and science continue to research and develop cures.

It is easy to criticize but I don't see any solutions. Does anyone?
Jeff
Posted 9/27/2010 11:01 PM (GMT 0)
"Third, keep in mind that the Provenge phase-3 trial showed a median improvement of 4.5 months survival. As you probably know, the way these drugs work is that they do work for some people, and others they simply don't work for. So, some men had far greater survival than the 4.5 month median value. The trial is required to report 3-year results, where 34% of the patients on Provenge were still alive, versus 11% for the placebo. In other words, the odds of being alive 3-years later were 3-times higher for those who took Provenge." <Casey>

"Median" means average. Half the subjects died before the 4.5 month mark and half died after...

34% were alive at the 3 year mark, while only 11% of the placebo subjects were. How many were in this study group? If you used 2.5 years instead of 3 years, what would the figures be then? Walsh's book, page 474, fig 12-2..

The point I'm trying to make is you can arrange statistics to "prove" almost any point you want...Whoever pays for the study usually gets the results they were aiming for.

The point of the article is that medical treatment costs are exploding, especially for cancer treatment, and left unchecked, they will bankrupt both Medicare and the private insurance industry..

The question nobody wants to ask, can society afford to pay $1 million dollars to extend the life of a 65 year old man for a few years??
Posted 9/28/2010 12:03 AM (GMT 0)
Survival of the Provenge group at the 2-year mark was 52.1%, and 41.2% for the placebo group.

The study was a double-blind placibo-controlled phase-3 clinical trial; I have no problem with the results.

As Jeff suggested, it's easy to be mindlessly critical without offering a better solution for others to consider...
Posted 9/28/2010 12:38 AM (GMT 0)
DES, a 40 year old $3 pill has had excellent and in some cases spectacular success in men brave enough to try it..Dr Mark Scholz and Ralph Blum, in their book, detail many successes that defy conventional treatment and wisdom and don't cost $93,000...

How many men could afford that if it was their own money?? Even if they COULD afford it, would they spend that kind of money to gain, hopefully, 4.5 months??

I would not...I'd get my affairs in order and give the $93K to someone who really needed it..
Posted 9/28/2010 7:39 PM (GMT 0)
DES is another tool in the tool kit for men who are no longer responding to hormone therapy (2 nd -line therapy) and have had spread outside of the prostate.   Years ago it was more frequently used, but it fell out of favor when Lupron was introduced in the mid-80’s because of greater safety and efficacy (results) with less severe side effects.   Severe heart & blood clotting problems have prevented it’s widespread use among elderly men…many of whom have heart and blood clotting issues.   The newer “skin patch” version of the estrogen seems to have reduced side effects and is growing in favor.   Probably lots of us have heard about the original use of DES as an anti-miscarriage agent prescribed to mothers in the post-WWII baby boomer era, which was later found to pass cervical cancer to their daughters and cause breast cancer in the mother.   Links of testicular cancer passed by DES-taking mothers to their sons has also been investigated, as well as 3 rd generation effects.   My mother took DES along with millions of others women.   It was later proven to be ineffective as an anti-miscarriage agent, and triggered some serious reform in the FDA to establish new criteria for both safety and effectiveness for the intended purpose.   For prostate cancer 2 nd -line therapy, DES does remain another tool in the existing tool kit that’s been around a long time, but it has been basically replaced by the more effective, more tolerant Lupron.   We need more novel breakthroughs and advancement like Provenge.     Provenge is revolutionary and may be the future of cancer treatments by attacking cancer from a molecular level .   The patient’s cells are collected and processed with proteins which helps activate the patient’s immune system and then infused back into the patient.   The treatment basically “re-trains” the patient’s own immune system to fight PC cells.   One size does not fit all when it comes to PC.   As far as I am concerned, anytime there is a revolutionary breakthrough on a new treatment mode (the first prostate cancer vaccine) it is extremely hopeful.  
Posted 9/28/2010 8:01 PM (GMT 0)
First, I ask does Medicare really pay for Provengeas someone stated.
Second. what is the requirements to get it.
Third, who is the first one to step up and make a sacrifice?

Meds like Taxes. Tax the Rich and there are no jobs. Poor people don't create jobs.
The makers have to have a profit or they won't do a darn thing.
Posted 9/28/2010 8:32 PM (GMT 0)

smilingoldcoot said...
...does Medicare really pay for Provengeas someone stated.


We'll find out soon:

http://blogs.wsj.com/health/2010/09/01/dendreon-shares-up-on-provenge-medicare-coverage-meeting-scheduling/

Posted 9/28/2010 9:02 PM (GMT 0)
DES- is not necessarily as risky as is painted in the picture upon review and newer Journal articles. Cost can be as low as .30-.40 per day for 1-mg.(no patents) I will post the Journal of Urology article again for anybody whom wants to read it.

http://ffyates.com/prostate/des.pdf  
www.pcainaz.com/Pages/ETE_eng.pdf    (Estradiol patches and some DES info)

Another vaccine idea in trials is DCVax right now.

Posted 9/30/2010 7:57 PM (GMT 0)
zufus, and/or others,

My understanding of DCVax is that it is similar to Provenge in that blood is drawn from the patient, shipped to a processing lab, infused, then shipped back and injected back into the patient to fight the cancer...so process-wise to the patient, it is similar in that it is a vaccine-type agent.

However, my understanding is that the targetted patient populations are different, so they are not competing products. Both are 2nd line HT (hormone independent PC), but Provenge is for metastatic patients and DCVax (if approved) would target non-metastatic patients.

Is this your understanding as well?   [Just trying to learn more about it...]

 

Post Edited (Casey59) : 9/30/2010 3:05:24 PM (GMT-6)

Posted 10/1/2010 12:54 PM (GMT 0)
I don't know much on DCVax only that is uses dendretic cells (which combine to PCa cells and help kill them off-thus vaccine concept), shouldn't have side effects or little if it doesn't mess up your immune system otherwise (you never know with new stuff). Works on metastatic or non-mets patients in trials, see article:

www.nwbio.com/clinical_dcvax_prostate.php       (mfg. info)

Looks promising, some claims by mfg. elsewhere, saying it may outperform Provenge...talk???

Post Edited (zufus) : 10/1/2010 6:57:51 AM (GMT-6)

Posted 10/1/2010 2:36 PM (GMT 0)
Zibotentan, mentioned a few days ago on this thread is dead. Astra Zeneca announced this week that the phase III trial was unsuccessful.

At this site, among others:
http://www.contrarianstrategist.com/tag/navid-malik

DCVax is discussed. The phase III trial of DCVAX in Prostate cancer was suspended because of cost. The company is pursuing the treatment in glioblastoma, brain cancer. The results will accumulate much faster for the treatment than for prostate cancer. If eventually aproved the carryover to other conditions may occcur.
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